UNSATISFACTORY COMPLAINTS RESOLUTION FROM BONITAS

This is sadly (but not surprisingly!) a follow up review for the review left on the 24 May. They emailed me, but the email was not satisfactory as it did not explain why the amount of R346.40 is coming off of a chronic benefit called 'managed care program' which I have asked for clarity about numerous times. "Please note that the test performed is payable from the Managed Care Programme Benefits."

Below are the Managed Care Benefits offered on the Standard and Standard Select options: - MENTAL WELLNESS - CANCER - DIABETES MANAGEMENT - BACK AND NECK - HIV/AIDS - HIP AND KNEE REPLACEMENT - HOSPITAL-AT-HOME

It doesn't make sense that the NK cells blood test is coming off of any of these. I need a manager to intervene here.

Practice no: *** Practice name: Du Buisson, Kramer, Swart, Bouwer Inc Treatment date: 18/05/2023 Beneficiary: Samantha Charged amount: 1385.60 Vendor amount: 346.40 Shortfall amount: 1039.20 Reference number: XUN92287

"An amount of R346.40 will be paid to the provider on the next payment run. Kindly note that tariff code 3816 was claimed four times and this code will only be paid up to the allowed quantity. Therefore, the three codes have been rejected and only one code has been paid as per the Scheme rules.

MENSTRUAL NK CELL PROFILE Bill code: 3816CBL Test Description: CD45+CD3-CD16+ % NK Cells Results: 41.4 % Bill code: 3816CBN Test Description: CD45+CD3-CD56+ % NK Cells Results: 49.7 % Bill code: 3816CBM Test Description:CD45+CD3+CD56+ % NKT Cells Results: 4.5 % Bill code: 3816CBLO Test Description:CD45+CD3+ % T Cells Results: 74.4

How can they say it is duplicate tests when the descriptions, bill codes and even the results are COMPLETELY AND CLEARLY DIFFERENT.

Why is this just accepted to be the patients problem? If the tariff codes need to be different then Bonitas needs to take this up with Ampath and get them to change the codes! A patient cannot get them to do this.